Natalie Woods is too tired, too empty to listen. She's been at the hospital since last night, when her husband died. Now her daughter is dead too.
But kneeling before her on the cold hospital floor is Janie Hibbler. She's asking for her daughter's 13-year-old heart. She also wants her kidneys, her pancreas and her liver.
"She could possibly help other people," Hibbler says over the roar of machines that are keeping this young heart pumping and lungs breathing.
"I would be with her the whole time," she says. "We would treat her with all the respect and love that she needs and that she deserves."
It is a moment replayed two dozen times a day across the country. Half the people who are asked say yes, enabling 17,000 organ transplants each year. The other half say no.
Much of the discussion surrounding organ transplants concerns how to divvy up the scarce organs available, with economic, political and geographic fights overlying the 4,000 people who die each year waiting for a transplant.
But the heart of any transplant begins in hospital rooms like this one, where a 13-year-old girl has died and a devastated family is forced to make a choice.
It's an ugly car crash. The Ford Taurus speeds off the long exit ramp of Interstate 95 and merges into traffic at 75 mph. The driver loses control and bounces off two cars before crossing the concrete divider, smashing into oncoming traffic and flipping into a ditch.
It's 6:55 p.m. Wednesday, and the driver is pronounced dead.
Critically injured, his young passenger still is breathing as an ambulance speeds her to Frankford-Torresdale Hospital. But hope fades fast in the emergency room as an X-ray shows a crushed brain.
The trauma surgeon calls the Delaware Valley Transplant Program.
"Jane Doe" is now a potential organ donor, although it will be two hours before her family gets first word of the accident. A transplant coordinator, Chris Carroll, makes his way to the hospital.
The intensive care unit is quiet except for room No. 4, where nearly a dozen doctors and nurses are working on Jane Doe as Carroll arrives.
Blood is filling her skull and sputtering out of her eyes, nose and swollen lips. Small pools collect on her light brown skin. Gauze is wrapped around her skull, as her long, black hair flows off the pillow.
A tiny braid still hangs along her face.
But nothing else is right. Her blood pressure is extraordinarily low, and there's little oxygen enriching her blood. Suddenly her heart stops, and doctors must shock it back.
Quickly assessing the situation, Carroll figures Jane Doe will not be an organ donor. Her family hasn't even been found. The best candidates are brain dead but stable long enough to allow a family to consider donation and for coordinators to make dozens of complex arrangements.
Meanwhile, the patient's lungs are filling with blood, and doctors attach tubes to her chest to drain them. Before long, plastic containers on either side of the bed will be filled red.
Natalie Woods is pacing, checking the window, watching for her husband's Ford Taurus to pull up. Anthony should have been home hours ago, and her back pains sharpen each time she sees it's not him. He and FaLon, her daughter from a previous relationship, were just going to the grocery store.
There is already enough stress in their lives. Yesterday, the family moved out of a homeless shelter and into a Days Inn. Natalie Woods is hoping the new car will help her husband find and keep a job.
Then she looks out and sees a police car:
There was a crash. Her husband is dead. Her daughter is in critical condition.
In intensive care, word comes that state troopers have found the girl's family. Jane Doe is now FaLon Willis, three days short of her 14th birthday. With the family on the way to the hospital, donation is suddenly a real possibility. Carroll calls his office to report her blood type, height and weight. The numbers are entered into a computer, and minutes later, hundreds of names awaiting transplants scroll across a screen.
Natalie Woods doesn't change out of house slippers before rushing to the hospital. Doctors give her the bottom line: FaLon isn't going to make it. She doesn't believe them.
"No," she says to herself. "My baby's going to make it."
She keeps hoping as she makes her way to room No. 4 and sees FaLon's swollen, bloody face, so different from the young woman who dreamed of being a model, whose sparkling eyes dance through the family photo album.
Woods clutches her hands over her mouth as she approaches.
"Oh my God. Oh! Oh!" she cries. "Mommy's here for you, honey. Oh, please. Oh, God. Please."
Dr. Charlie Goldstein explains that doctors haven't yet performed tests to determine whether FaLon is brain dead, although they are virtually certain she is.
Woods rocks side to side as she tries to absorb so much information.
Suddenly she doubles over, leaning on a nearby nurse who guides her to a wheelchair. She's wheeled away from her baby, back to the waiting room, to wait.
Two tests--performed six hours apart by different doctors--are required to pronounce someone brain dead. Brain death occurs when there is no activity in the life-sustaining centers of the brain. It's a tough concept to grasp because victims often don't look dead, and families may think they are simply in a coma. But brain death is death, and there's no chance for recovery.
It's now 1:20 a.m. Thursday, eight hours after the car crash, but the first brain-death test is still hours away. First nurses must warm FaLon up; she's so cold, it's possible that's what is keeping blood from her brain. Nurses cover her with a warming blanket.
The young girl under the blanket is but a shell of the vibrant child who loved to play with little kids and didn't mind kisses from her mom and younger brother.
FaLon Caprice Willis dreamed of being a singer, or an artist or a model. Or maybe a teacher. Her parents never went to college, but she was headed for honors English in ninth grade this fall.
Her family was less than stable, bouncing from shelters to motels to public housing. She made friends easily, and it hurt when she changed schools.
Her mother would later find herself reading FaLon's poetry over and over. "I've got too much to think about," FaLon wrote, "and so little time."
A 20-page fax of names waiting for transplants is delivered to Chris Carroll. It's too early to approach Woods--that won't come until FaLon is pronounced dead. But Carroll needs to set the wheels turning.
He asks a nurse to collect a few vials of blood to test for HIV, hepatitis and other infections.
A nurse himself, he works alongside the medical staff all night, and as morning breaks, he's surprised FaLon is still hanging on--he figured her heart would give out. But her blood pressure is strong, and her body warm.
At 7:43 a.m., Goldstein signs the form certifying that FaLon meets the criteria for brain death: Her eyes don't respond to light; she shows no reaction to intense pain. Pouring ice water into each ear brings no response.
Janie Hibbler drives to Frankford-Torresdale Hospital with her heart in her throat. It's her second 13-year-old in a week; the last time it was a boy who killed himself, and Hibbler is still hurting.
She's been sent to relieve Carroll. First, she has nurses inject drugs to help preserve FaLon's organs. She orders an X-ray of FaLon's heart to see how it's functioning. She alerts the operating room that they may need a spot on the schedule. She checks lab results to help match organs with recipients.
But her frantic pace slows as she approaches FaLon's grandparents.
She takes the grandmother's hand and holds on longer than she has to. She wants the family to hear the facts about donation. She's worried FaLon's mother may say no without talking with her first.
But she only briefly mentions donation, helping the family sort through FaLon's death.
"She's in no pain. Know that, know that," Hibbler says.
"[God] gives us trials and tribulations," the grandfather says.
"But never more than you can handle," Hibbler says, tears in her eyes.
It's noon Thursday, and Hibbler begins calling surgeons, careful to tell them that the potential donor is not yet officially dead and her parents have not yet officially consented. But Hibbler needs to be ready.
She calls Dr. Harry Yang of Hershey Medical Center to offer the liver, the organ in highest demand because there's no way to keep patients alive while waiting for a donor.
Livers are offered to patients in the area, sickest first, and Yang's patient is at the top of the list. Hibbler tells him the liver is torn. Yang, consulting with a colleague, gives a quick answer: "No."
The second call goes to the University of Pennsylvania, where surgeon Abraham Shaked has the opposite reaction: "I'll take it," he says. Hearing about the tear does nothing to change his mind.
It's time for the second brain-death exam. Woods and Jesse Willis, FaLon's natural father, sit silently in room No. 4 as a neurologist they've never met rushes in, performs the tests and, two minutes later, rushes out, looking for the papers to sign.
FaLon's parents have no idea who this man is or why he was shaking their daughter's head so hard. He has already signed the chart pronouncing her dead; it will be half an hour before another doctor tells them.
Then Hibbler enters the cramped hospital room. There is nowhere left to sit, so she kneels before them to ask.
She explains the donation procedure (like a normal operation) and the cost (none to the family). She answers a few questions.
The parents sign the consent form. It was an easy decision, Woods says. When FaLon's grandmother died a few years ago, FaLon volunteered that she would like to be a donor if anything happened to her.
"She wanted to help other people," her mother says.
"She'll be helping a whole lot of people," Hibbler responds. "All the tears you cry here today, other people will be crying the opposite, the tears of joy, when they hear they have a heart for their loved one."
It's now 4:30 p.m. Thursday, and FaLon's heart, liver, pancreas and kidneys have been placed with local hospitals. Surgeons are on their way to Frankford-Torresdale to remove them.
But before FaLon is wheeled to the operating room, Woods spends a few minutes alone with her.
She takes her hands, touches her body, brushes her hair. She pulls off the blankets, "just to see her body one more time."
And she tries to figure out why.
"I felt like I was being punished," she says later. "I couldn't understand. Why my baby?"
At 6 p.m. FaLon is wheeled to the OR; portable machines keep her heart and lungs moving. They'll continue to function until surgeons have opened her chest and cut her organs away from all but the vital connections needed to circulate blood.
The room is bright, cold and sterile--just like a normal operation.
At 7:46 p.m. surgeons fix clamps on the arteries supplying blood to the heart. Cold preservation solution is flushed into FaLon's abdomen and ice is poured over her organs. Blood is suctioned out. And the clock starts ticking: four hours to get the heart into its new owner, 24 hours for the liver, 48 hours for the kidneys.
The heart comes out first, and a surgeon holds it in one hand as he repairs a small hole. Soon it will be powering the body of a 56-year-old carpenter.
Twenty-five minutes after the clock began ticking, the heart is off in a red Playmate cooler to Temple University.
Surgeons move to the other organs. The pancreas--along with one of the kidneys--will be put into a 31-year-old woman who has gone blind from diabetes. The other kidney will go to the patient who will receive the liver.
And the liver's condition? "Perfect," says University of Pennsylvania surgeon Kim Olthoff. What about the cut? "It's just a bruise," she says; a 13-year-old liver is so healthy it doesn't really matter.
But it takes longer than usual to remove the liver and pancreas. Dr. Abraham Shaked, usually friendly and coolheaded, is on the phone yelling at Hibbler that his patient, a 40-year-old man with six children, is on an operating table, waiting for his liver.
Hibbler must juggle the egos and tempers of the surgeon on the phone and the surgeon at the table.
A sheet shields FaLon's head from the activity around her. Her body is empty. Still, the lone braid lies atop her hair, flowing off the back of the table.
Midnight, and the surgeons have all gone back to their hospitals, carrying their cargo in boxes marked "Handle with care." FaLon's chest has been stitched shut, and soon she'll be in the care of the medical examiner.
Aides clean up the OR, filling bag after bag with bloody towels.
But Hibbler's job isn't done.
She takes a basin of warm, soapy water and begins to wash FaLon's body. In slow, circular motions, she removes the blood and grime from her face, her shoulders, her chest--all the way down to her feet.
When she's done, she folds FaLon's arms on her chest and crosses her ankles. With the body bag ready to receive its cargo, Hibbler touches FaLon's forehead, shakes her head and smiles a sad smile.
"It's closure for me too," Hibbler says. "It's my way of thanking her and saying goodbye."
FaLon's heart, liver, pancreas and two kidneys were successfully transplanted into three patients. All three are doing well, living in the Philadelphia area.